Provider Demographics
NPI:1306022470
Name:MORRIS, MINDI M (MD)
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:M
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-7736
Mailing Address - Country:US
Mailing Address - Phone:812-886-4572
Mailing Address - Fax:812-886-6571
Practice Address - Street 1:429 PERRY ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2127
Practice Address - Country:US
Practice Address - Phone:812-886-4572
Practice Address - Fax:812-886-6571
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063852A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200898480AMedicaid